Cultural Competence Handbook
Cultural CompetenceHandbookCounty of San Diego Behavioral Health ServicesNovember 2017
Document Prepared by:County of San Diego Behavioral Health Services (SDCBHS)Quality Improvement UnitIn collaboration with The Cultural Competence Resource Team2 Page
Table of ContentsIntroduction6County of San Diego, Health and Human Services Agency Vision, Mission, andStrategy7Behavioral Health Services, Vision, Mission, and Guiding Principles7The Importance of Cultural Competence8Cultural Competence Rollout and History9CLAS Standards10Cultural Competence Plan11Cultural Competence Plan Development Guidelines12Cultural Competence Plan Development Checklist13Evaluating Cultural Competence15Available Tools for Program Evaluation16Cultural and Linguistic Competence Policy Assessment (CLCPA)17Promoting Cultural Diversity Self-Assessment (PCDSA)39Certification of Language Competence51Survey for Clients to Assess Program’s Cultural Competence53Discussion Questions for Client Focus Groups on Program’s CulturalCompetenceDiscussion Questions for Community Focus Groups on Program’s CulturalCompetenceResources575961National Standards for CLAS in Health and Health Care62Context for the Development and Evaluation of Cultural Competences63Suggestions for Supplemental Cultural Competence Training65Supplemental Cultural Competence Training Evaluation Form69Additional Resources713 Page
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Cultural CompetenceHandbook5 Page
IntroductionThe County of San Diego is richly diverse, beyond ethnicity; cultures are dynamic and unique. Wecelebrate the wealth of diversity and the demographics below are just one indication of our culturalwealth. The Agency, providers, and community partners face a unique opportunity when engagingculture sensitivity. One way is our continued integration of trauma-informed systems. Beingtrauma-informed is a philosophy, a component of cultural competence; an approach to engage allpeople we serve, all staff and those we encounter whilst conducting business. Cultural norms,values, beliefs, customs, and behaviors may influence behavioral health and medical issues, soauthentic engagement and developing relationships with those we serve will guide our work withpositive outcomes as the intent. On July 13, 2010, the County Board of Supervisors took a boldand innovative leap forward in the area of health policy by adopting a 10‐year health strategyagenda to improve the health of our region. This highly innovative strategy agenda aims to improvethe health and well‐being of county residents through four key pillars: 1) Building a Better ServiceDelivery System, 2) Supporting Positive Healthy Choices, 3) Pursuing Policy and EnvironmentalChanges, and 4) Improving the Culture from Within County Government.WhiteHispanicAfrican AmericanAsian/Pacific IslanderNative AmericanLGBTQIVeteransAge 0-17Age 18-24Age 25-59Age 60 2010United StatesCensus Data2010San Diego CountyCensus DataFY 2015-16Behavioral HealthServices231,040,398 (74.8%)50,477,594 (16.4%)42,020,743 (13.6%)17,320,856 (5.6%)5,220,579 (1.7%)9,083,558* (2.9%)26,403,703 (8.5%)74,181,467 (24.0%)30,672,088 (9.9%)146,806,075 (47.6%)57,085,908 (18.5%)1,981,442 (64.0%)991,348 (32.0%)158,213 (5.1%)351,428 (11.4%)26,340 (0.9%)300,000** (9.6%)292,034 (9.4%)821,263 (26.5%)270,750 (8.8%)1,502,564 (49.0%)500,736 (16.2%)21,690 (36.1%)19,448 (32.4%)6,902 (11.5%)2,802 (4.4%)404 (0.7%)2,131 (3.5%)1,482 (2.5%)16,303 (27.1%)8,525*** (14.2%)29,686*** (49.4%)5,592 (9.3%)For additional information on BHS client demographics, visit the BHS Technical Resource Library tal health services act/technical resource library.html*The information on adult LGBTIQ population in the US was obtained from The Williams Institute, UCLA School of Law.**This number is approximate based on the information from Behavioral Health Education and Training AcademyNote: the percentages are based on the total 2010 US population (308,745,538), 2010 San Diego County (3,095, 313)population, and FY 2015-16 BHS client population (60,106).***The BHS client age groups are 18-25 and 26-59.In alignment with Live Well San Diego, the Health and Human Services Agency Behavioral HealthServices Division (BHS) continually works toward the complete integration of systems and services.Within this integration process, BHS is working to fully incorporate the recognition of the personalexperiences within cultural diversity and sees the creation of an integrated culturally competent andtrauma-informed Behavioral Health system as a developmental process. BHS has demonstratedcommitment to cultural competence and trauma-informed systems; continually enhancing strategiesand efforts for enhancing wellness and reducing all disparities; cultural competence evaluation andtraining activities; the continued development of a multicultural workforce; and continued integrationof systems and services. As part of our goal to enhance well-being and reduce disparities for allpopulations, the SDCBHS presents this Cultural Competence Handbook. The Handbook containstools that will assist behavioral health providers in making improvements throughout the system ofcare.6 Page
County of San Diego, Health and Human Services AgencyVision:Healthy, Safe, and Thriving San Diego CommunitiesMission:To make people’s lives healthier, safer, and self-sufficient by delivering essentialservices.Strategy:1. Building a Better System focuses on systems and how the County delivers services.How it can further strengthen partnerships to support better health and wellbeing.For example, being trauma-informed is a component of cultural competencytherefore the County is integrating physical and mental health given the bidirectional connectivity and making the systems and services easier to access.2. Supporting Healthy Choices provides information and educates residents so theyare aware of how their choices may impact their health. The plan highlights chronicdiseases because these are largely preventable and we can make a differencethrough awareness and education.3. Pursuing Policy Changes for a Healthy Environment is about creating policies andcommunity changes to support recommended healthy choices.4. Improving the Culture from Within. As an employer, the County has a responsibilityto educate and support its workforce so employees “walk the talk”. Simply said,change starts with the County as we practice what we teach.Behavioral Health ServicesVision:Safe, mentally healthy, addiction-free communitiesMission:In partnership with our communities, work to make people’s lives safe, healthy andself-sufficient by providing quality behavioral health services.Guiding Principles:1. To foster continuous improvement to maximize efficiency and effectiveness ofservices.2. To support activities designed to reduce stigma and raise awareness surroundingmental health, alcohol and other drug problems.3. To maintain fiscal integrity.4. To ensure services are: outcome-driven; culturally competent; recovery andclient/family centered; innovative and creative; and trauma-informed.5. To assist County employees to reach their full potential.7 Page
The Importance of Cultural CompetenceCultural Competence is a set of congruent behaviors, attitudes, and policies that cometogether in a system, agency, or among consumer providers, family member providers, andprofessionals that enables that system, agency or those professionals, consumer, andfamily member providers to work effectively in cross-cultural situations.The National Center for Cultural Competence has identified six salient reasons toincorporate cultural competence into organizational policy:1. To respond to current and projected demographic changes in the United States.2. To eliminate long-standing disparities in the health status of people of diverse racial,ethnic and cultural backgrounds.3. To improve the quality of services and health outcomes.4. To meet legislative, regulatory and accreditation mandates.5. To decrease the likelihood of liability/malpractice claims.For more details, visit o support the needs of our diverse populations SDCBHS recommends that all providersbe committed to prioritizing cultural competence. This goal can be achieved through thefollowing:1. Incorporating trauma-informed and cultural competencies throughout the provider’s:i. Mission Statementsii. Guiding Principlesiii. Policies and Procedures2. Development or enhancement of a Cultural Competence Plan.3. Implementing the National Culturally and Linguistically Competent Services (CLAS)Standards.4. Periodic evaluation of staff, programs and clients.5. Ensuring that the clinical practice is based on trauma-informed care, culturalawareness, and life-long enhancement of knowledge and skills.This Cultural Competence Handbook provides timelines, guidelines, and examples ofmethods and tools that are recommended and can be used to guide programs in achievingthe goal of enhancing wellness and reducing disparities.Behavioral Health Services Cultural CompetenceExpectations for ProvidersEach legal entity isrequired to submit aCultural CompetencyPlan (CC Plan)Every year, eachcontract mustrespond to theCultural andLinguisticCompetence PolicyAssessment (CLCPA)Every two years, staffmust respond to thePromoting CulturalDiversity SelfAssessment (PCDSA)8 Page
Cultural Competence Rollout1 TimeCultural Competence Plan(CC Plan)Cultural and LinguisticCompetence PolicyAssessment(CLCPA)2 YearsWhatAnnualWhoWhenSubstance Use DisorderServices (SUD)Promoting Cultural DiversitySelf-Assessment(PCDSA)Mental Health Services(MHS)Required for all Legal Entities as of December 2013Updates as neededOctober 2017October 2018October 2019February 2018February 2020Cultural Competence HistoryCultural Competence ProgramAnnual Self-Evaluation (CC-PAS)California Brief MulticulturalCompetence Scale (CBMCS)CC PlanApril 2012 (MHS only)April 2013 (MHS only)April 2014 (MHS and SUD)April 2015 (MHS and SUD)April 2016 (MHS and SUD)October 2011 (MHS only)October 2013 (MHS & SUD)October 2015 (MHS & SUD)April 2012 (MHS)December 2014 (SUD)9 Page
The enhanced National Standards for Culturally and Linguistically Appropriate Services in Health and HealthCare (CLAS Standards) were developed by the Health and Human Services Office of Minority Health and areintended to advance health equity, improve quality, and help eliminate health care disparities (see theResources section). Implementing strategies to improve and ensure cultural and linguistic competency in thebehavioral health care systems using the CLAS standards is a powerful way to address disparities and ensureall populations have equal access to services and supports. In addition to the new requirements in eachprograms’ Statements of Work for adhering to CLAS standards, the following chart shows how CLAS Standardsare already embedded into cultural competence evaluation tools provided in the Handbook.CLAS StandardsCLCPA1. Provide effective, equitable, understandable, and respectful quality care andservices that are responsive to diverse cultural health beliefs and practices,preferred languages, health literacy, and other communication needs. PCDSACC PlanPrincipal Standard: Governance, Leadership, and Workforce:2. Advance and sustain organizational governance and leadership thatpromotes CLAS and health equity through policy, practices, and allocatedresources.3. Recruit, promote, and support a culturally and linguistically diversegovernance, leadership, and workforce that are responsive to the population inthe service area.4. Educate and train governance, leadership, and workforce in culturally andlinguistically appropriate policies and practices on an ongoing basis. Communication and Language Assistance:5. Offer language assistance to individuals who have limited Englishproficiency and/or other communication needs, at no cost to them, to facilitatetimely access to all health care and services.6. Inform all individuals of the availability of language assistance servicesclearly and in their preferred language, verbally and in writing.7. Ensure the competence of individuals providing language assistance,recognizing that the use of untrained individuals and/or minors as interpretersshould be avoided.8. Provide easy-to-understand print and multimedia materials and signage inthe languages commonly used by the populations in the service area.Engagement, Continuous Improvement, and Accountability:9. Establish culturally and linguistically appropriate goals, policies, andmanagement accountability, and infuse them throughout the organization’splanning and operations.10. Conduct ongoing assessments of the organization’s CLAS-relatedactivities and integrate CLAS-related measures into measurement andcontinuous quality improvement activities.11. Collect and maintain accurate and reliable demographic data to monitorand evaluate the impact of CLAS on health equity and outcomes and to informservice delivery.12. Conduct regular assessments of community health assets and needs anduse the results to plan and implement services that respond to the cultural andlinguistic diversity of populations in the service area.13. Partner with the community to design, implement, and evaluate policies,practices, and services to ensure cultural and linguistic appropriateness.14. Create conflict and grievance resolution processes that are culturally andlinguistically appropriate to identify, prevent, and resolve conflicts orcomplaints.15. Communicate the organization’s progress in implementing and sustainingCLAS to all stakeholders, constituents, and the general public. Source: Think Cultural Health, Office of Minority Health, U.S. Department of Health and Human ServicesFor more information and to access CLAS standards visit www.thinkculturalhealth.hhs.gov/clas.10 P a g e
Cultural Competence PlanAn outline for the development of aCultural Competence Plan11 P a g e
Cultural Competence Plan Development GuidelinesGoal: To provide guidelines to assist and guide programs to develop a plan that enhances theircurrent capability for providing trauma-informed and culturally competent systems and services.Background: As stated in all SDCBHS contracts, it is an expectation that the organizationsdevelop and provide trauma-informed and culturally competent systems and services, and workto continually enhance levels of cultural competence. This complements the expectation that theCalifornia Department of Health Care Services (DHCS) has for each county. The guidelinesbelow, developed by SDCBHS with input from the Cultural Competence Resource Team(CCRT), can be used as a tool as your organization works to assess the current culturalcompetence and integrate the plan components into the system of care. If you do not have aCultural Competence Plan in place currently, please ensure the following components areaddressed. If you already have a Cultural Competence Plan in place, please evaluate todetermine adding any of the elements noted in these guidelines could enhance your plan.Cultural Competence Plan Component Guidelines: Current Status of Programo Document how the mission statements, guiding principles, and policies and proceduressupport trauma-informed cultural competence.o Identify how program administration prioritizes cultural competence in the delivery ofservices.o Agency training, supervision, and coaching incorporate trauma-informed systems andservice components.o Goals accomplished regarding reducing health care disparities.o Identify barriers to quality improvement. Service Assessment Update and Data Analysiso Assessment of ethnic, racial, linguistic, and cultural strengths and needs of thecommunity.o Comparison of staff to diversity in community.o A universal awareness of trauma is held within Agency. Trauma is discussed andassessed when needed and relevant to client/target population needs.o Use of interpreter services.o Service utilization by ethnicity, race, language usage, and cultural groups.o Client outcomes are meaningful to client’s social ecological needs. Objectiveso Goals for improvements.o Develop processes to assure cultural competence (language, culture, training, surveys)is developed in systems and practiced in service delivery.- Trauma-informed principles and concepts integrated- Faith-based servicesThe checklist on page 13 may serve as a resource for incorporating Cultural Competence Plancomponents into your policies and procedures. It’s provided for reference only.Please note: As of December 2013, Cultural Competence Plans are required for all legal entitiesfor both mental health and alcohol and drug services. For legal entities with multiple programs,please consider a Cultural Competence Plan per program.12 P a g e
Cultural Competence Plan Development ChecklistSDCBHS recommends the use of this toolApprox.Impl.Date:Met:CULTURAL COMPETENCE PLANCOMPONENTS:InProgress:COMPONENT IMPLEMENTATIONResourcesUsed:Date Met:In response to what dataor information was thechange/innovation/improvement made?Current Status of ProgramDocument how the mission statements,guiding principles, and policies andprocedures support trauma-informedcultural competence.Identify how program administrationprioritizes cultural competence in thedelivery of services.Agency training, supervision, andcoaching incorporate trauma-informedsystems and service components. Goals accomplished regarding reducinghealth care disparities. Identify barriers to quality improvement. Service Assessment Update and Data AnalysisAssessment of ethnic, racial, linguistic,and cultural strengths and needs of thecommunity.Comparison of staff to diversity incommunity.A universal awareness of trauma is heldwithin Agency. Trauma is discussed andassessed when needed and relevant toclient/target population needs. Use of interpreter services. Service utilization by ethnicity, race,language usage, and cultural groups. Client outcomes are meaningful toclient’s social ecological needs. ObjectivesGoals for improvements.Develop processes to assure culturalcompetence (language, culture, training,surveys) is developed in systems andpracticed in service delivery.a) Trauma-informed principles andconcepts integratedb) Faith-based services Example:Client outcomes are meaningful to client’ssocial ecological needs. ClientFocusGroupDec 13Part of client-focusedinitiative.The CLAS Standards offer a strong framework to provide culturally and linguistically appropriateservices. As they are already embedded into cultural competence evaluation tools in the Handbook, theprograms will adhere to the Standards by utilizing the tools, follow the established Cultural CompetencePlan, and complete regularly scheduled evaluations as noted in the Rollout on page 9.13 P a g e
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Evaluating CulturalCompetence15 P a g e
Available Tools for Program EvaluationThe following tools are included in the Handbook to assist programs with evaluating theircultural and linguistic competence. Programs are required to use the CLCPA and PCDSAas directed by County of San Diego Behavioral Health Services. Evaluations for otherareas may be done by using the tools noted or other tools that your program or legal entityhas identified that meet the same criteria. Cultural and Linguistic Competence Policy Assessment (CLCPA) Promoting Cultural Diversity Self-Assessment (PCDSA) Certifica
Promoting Cultural Diversity Self-Assessment (PCDSA) Every year, each contract must respond to the Cultural and Linguistic Competence Policy Assessment (CLCPA) The Importance of Cultural Competence . Cultural Competenceis a set
Cultural competence needs to be seen as a continuum from basic cultural awareness to cultural competence; effort must be made to move beyond knowledge towards cultural sensitivity and competence (Adams, 1995). Developing sensitivity and understanding of another ethnic group Cultural awareness must be
UNI 1 NATURA CIENC LEARN TOGETHER PRIMARY 3 33 LIN Competence in linguistic communication MST Competence in mathematics, science and technology DIG Competence in the use of new technologies LTL Competence in learning to learn SOC Competence in social awareness and citizenship AUT Competence in autonomous learning and personal initiative CUL Competence in artistic and cultural awareness
4. Cultural Diversity 5. Cultural Diversity Training 6. Cultural Diversity Training Manual 7. Diversity 8. Diversity Training 9. Diversity Training Manual 10. Cultural Sensitivity 11. Cultural Sensitivity Training 12. Cultural Sensitivity Training Manual 13. Cultural Efficacy 14. Cultural Efficacy Training 15. Cultural Efficacy Training Manual 16.
A. The need for a cultural competence framework B. Creating a process for change C. Broadening the Concept of Cultural Competence Cultural Competence Issues to Consider Developing Cultural Competence in Disaster Mental Health Programs: Guiding Principles and Recommendations Selected Referen
assess cross-cultural competence of Soldiers. Findings are presented in four main sections. The first section discusses the importance of cross-cultural competence to mission accomplishment and describes two facets of cross-cultural competence: cultural learning and cult
Topic 1 Reflecting on your own cultural identity and biases . 1 1A Reflect on your cultural heritage 3. 1B Understand cultural competence 7 Summary 12. Learning checkpoint 1: Reflecting on your own cultural identity 13. Topic 2 Identifying and developing cultural competency . 15 2A Devel
The Process of Cultural Competence in the mDelivery of H e a l t h c a re Services is a practice model of cultural competence that defines cultural competence as the ongoing process in which the nurse continuously strives to achieve the ability and availabili-ty to work effectively within the cultural context of the patient
Aliens' Behaviour Connectives Game This game was originally developed in 2006 for Year 5/6 at Dunkirk Primary School in Nottingham. It has also been used at KS3. We have chosen this topic because we hope it will encourage children to produce their own alien names (a useful use of phonically regular nonsense words!), portraits and sentences .
